Departments of Surgery, Medicine, and Nursing, University of California at Los Angeles, Los Angeles, California, Gilead Sciences, Foster City, and the Los Angeles County Department of Public Health, Los Angeles, California.
Obstet Gynecol. 2020 Apr;135(4):773-777. doi: 10.1097/AOG.0000000000003704.
Hepatitis C virus (HCV) infection affects 170 million people worldwide, with at least 5% of individuals with HCV progressing to life-threatening complications, including hepatocellular carcinoma, within 20 years from acute infection. The World Health Organization has called for viral hepatitis elimination as a major public health threat by 2030. The recent development and availability of direct-acting antiviral drugs have been a game-changer in the HCV-treatment paradigm-response exceeds 90%, with minimal adverse events. Accordingly, the U.S. Preventive Services Task Force and the American Association for the Study of Liver Disease-Infectious Diseases Society of America 2019 guidelines recommend universal HCV screening for all adults aged 18-79 years, including pregnant women. Worldwide, up to 8% of pregnant women have HCV infection, with the prevalence being as high as 4% in the United States. Pregnancy is one of the few points of contact women of reproductive age have with their health care providers; therefore, pregnancy provides a crucial time for targeting this population for HCV screening. Children also benefit from maternal screening, because the primary route of infection in children is vertical transmission during pregnancy, and children are not routinely assessed for liver disease. In fact, 85-95% of children with HCV infection in the United States are not yet identified with current strategies. In this commentary, we highlight why universal screening in pregnant women should be recommended by the American College of Obstetricians and Gynecologists based on the current epidemiology of HCV and the upcoming U.S. Preventive Services Task Force-recommended screening changes for all adults aged 18-79 years. We also review the current screening paradigm and treatment options for pregnant women and their children.
丙型肝炎病毒（HCV）感染影响全球 1.7 亿人，至少有 5%的 HCV 感染者在急性感染后 20 年内会发展为危及生命的并发症，包括肝细胞癌。世界卫生组织呼吁到 2030 年消除作为重大公共卫生威胁的病毒性肝炎。直接作用抗病毒药物的最近发展和可用性改变了 HCV 治疗模式，应答率超过 90%，不良反应最小。因此，美国预防服务工作组和美国肝病研究协会传染病学会 2019 年指南建议对所有 18-79 岁的成年人（包括孕妇）进行普遍 HCV 筛查。全世界多达 8%的孕妇感染 HCV，美国的患病率高达 4%。怀孕是育龄妇女与医疗保健提供者接触的少数几个点之一；因此，怀孕为针对该人群进行 HCV 筛查提供了一个关键时期。儿童也受益于母婴筛查，因为儿童感染的主要途径是妊娠期间的垂直传播，而且儿童通常不进行肝脏疾病评估。事实上，在美国，85-95%的 HCV 感染儿童尚未通过当前策略确定。在这篇评论中，我们强调了为什么美国妇产科医师学会应该根据当前 HCV 的流行病学和即将到来的美国预防服务工作组建议对所有 18-79 岁成年人进行普遍筛查的建议，推荐对孕妇进行普遍筛查。我们还回顾了孕妇及其子女的当前筛查模式和治疗选择。
